Sec. 7. Increasing opportunities and accountability for primary care residency training
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Section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) is amended— in paragraph (4)(F)(i), by striking paragraphs
(7)and
(8)and inserting paragraphs (7), (8), and
(9); in paragraph (4)(H)(i), by striking paragraphs
(7)and
(8)and inserting paragraphs (7), (8), and
(9); in paragraph (7)(E), by inserting paragraph (9), after paragraph (8), ; and by adding at the end the following new paragraph: For fiscal year 2014 (and succeeding fiscal years if the Secretary determines that there are additional residency positions available to distribute under subparagraph (D)), the Secretary shall increase the otherwise applicable resident limit for each qualifying hospital that submits a timely application under this subparagraph by such number as the Secretary may approve for portions of cost reporting periods occurring on or after July 1 of the fiscal year of the increase. Such additional residency positions shall be for approved medical residency training programs (as defined in paragraph (5)(A)) in family medicine. Subject to clause (iii), a hospital that receives an increase in the otherwise applicable resident limit under this paragraph shall ensure, during the 5-year period beginning on the date of such increase, that— the number of full-time equivalent residents in family medicine (as determined by the Secretary), excluding any additional positions under subclause (II), is not less than the average number of full-time equivalent residents in family medicine (as so determined) during the 3 most recent cost reporting periods ending prior to the date of enactment of this paragraph; and 100 percent of the positions attributable to such increase are in an approved medical residency training program in family medicine (as determined by the Secretary). In the case where the Secretary determines that a hospital described in clause
(ii)does not meet either of the requirements under subclause
(I)or
(II)of such clause, the Secretary shall— reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this paragraph; and provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph. The aggregate number of increases in the otherwise applicable resident limit under this paragraph shall be equal to 2,000. The Secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as result of an increase in the otherwise applicable resident limit by January 1 of the fiscal year of the increase. Such increase shall be effective for portions of cost reporting periods beginning on or after July 1 of that fiscal year. If the number of resident full-time equivalent positions distributed under this paragraph in fiscal year 2014 is less than the aggregate number of positions available for distribution in the fiscal year under subparagraph (B), the Secretary shall conduct an application and distribution process in subsequent fiscal years until such time as the aggregate number of positions distributed under this paragraph is equal to the aggregate number under subparagraph (B). In determining for which hospitals the increase in the otherwise applicable resident limit is provided under this paragraph, the Secretary shall prioritize training programs with an emphasis on community-based training, and shall prioritize hospitals with a demonstrated likelihood of filling the positions with residents who will practice in health professional shortage areas (as defined by the National Health Service Corps under section 332 of the Public Health Service Act (42 U.S.C. 254e)) or with medically underserved populations (as defined in section 330(b)(3) of the Public Health Service Act ( 42 U.S.C. 254b(b)(3) )), as determined by the Secretary. In this paragraph, the term otherwise applicable resident limit means, with respect to a hospital, the limit otherwise applicable under subparagraphs (F)(i) and
(H)of paragraph
(4)on the resident level (as defined in paragraph (7)(C)(i)) for the hospital determined without regard to this paragraph but taking into account paragraphs (7)(A), (7)(B), (8)(A), and (8)(B). . Section 1886(d)(5)(B)(v) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second sentence, is amended by striking subsections (h)(7) and (h)(8) and inserting subsections (h)(7), (h)(8), and (h)(9) . Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— by redesignating clause (x), as added by section 5505(b) of the Patient Protection and Affordable Care Act ( Public Law 111–148 ), as clause
(xi)and moving such clause 4 ems to the left; and by adding after clause (xi), as redesignated by subparagraph (A), the following clause: For discharges occurring on or after July 1, 2014, insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection (h)(9), the indirect teaching adjustment factor shall be computed in the same manner as provided under clause
(ii)with respect to such resident positions. . Section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)), as amended by subsection (a)(1), is amended by adding at the end the following new paragraph: Notwithstanding the preceding provisions of this subsection, for fiscal year 2014 and subsequent fiscal years, a hospital shall not receive any payments under this subsection or subsection (d)(5)(B) (or any other payments under this title for graduate medical education costs) in a fiscal year unless the hospital complies with the following requirements, as determined by the Secretary: The hospital has an approved medical residency program in— family medicine; or adult or all-age primary care. Each fiscal year (beginning with fiscal year 2014), the hospital submits to the Secretary a report that contains the following information with respect to residents of the hospital: The total amount of money generated by the residents (by residency type) in each year of their residency program. The total amount of Federal funding provided to the hospital for training residents, by residency type, in each year of the residency program. The average number of inpatient and outpatient encounters per year by residency type in inpatient and outpatient settings. A justification for the hospital’s allocation of residency slots across specialties and subspecialties that is responsive to local and national health care workforce needs and recommendations put forth by the National Health Care Workforce Commission. A detailed breakdown of how the hospital uses amounts received under this subsection and under subsection (d)(5)(B). Not later than 30 days after receiving the report under subparagraph (A)(ii), the Secretary shall post the information described in subclauses
(I)through
(VI)of such subparagraph on the Internet Website of the Centers for Medicare & Medicaid Services. . Section 1886(d)(5)(B) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(B) ), as amended by subsection (a)(2)(B), is amended by adding at the end the following new clause: The requirements under subsection (h)(10) shall apply to payments under this subparagraph in the same manner as such requirements apply to payments under such subsection. .
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- Pub. L. 111-148
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Sec. 7
Increasing opportunities and accountability for primary care residency training
Pub. L.Pub. L. 111-148
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